Presentation is loading. Please wait.

Presentation is loading. Please wait.

Respiratory distress Cause of significant morbidity and mortality

Similar presentations

Presentation on theme: "Respiratory distress Cause of significant morbidity and mortality"— Presentation transcript:

1 Respiratory distress Cause of significant morbidity and mortality
Incidence 4 to 6% of live births Many are preventable Early recognition, timely referral, appropriate treatment essential

2 Respiratory distress RR > 60/ min* Retractions Grunt + Cyanosis
* Tachypnea

3 Causes of respiratory distress
Pulmonary Cardiac- Congenital heart disease CNS- Asphyxia, IC bleed Metabolic-Hypoglycemia, acidosis

4 Causes of respiratory distress - Medical
Respiratory distress syndrome (RDS) Meconium aspiration syndrome (MAS) Transient tachypnoea of newborn (TTNB) Asphyxial lung disease Pneumonia- Congenital, aspiration, nosocomial Persistent pulmonary hypertension (PPHN)

5 Surgical causes of respiratory distress
Tracheo-esophageal fistula Diaphragmatic hernia Lobar emphysema Pierre -Robin syndrome Choanal atresia

6 Approach to respiratory distress
History Onset of distress Gestation Antenatal steroids Predisposing factors- PROM, fever Meconium stained amniotic fluid Asphyxia

7 Approach to respiratory distress
Examination Severity of respiratory distress Neurological status Blood pressure, CFT Hepatomegaly Cyanosis Features of sepsis Look for malformations

8 Assessment of respiratory distress
Score * Resp. rate < >80 Central None None with Needs cyanosis % FiO >40% FiO2 Retractions None Mild Severe Grunting None Minimal Obvious Air entry Good Decreased Very poor * Score > 6 indicates severe distress

9 Approach to respiratory distress
Chest examination Air entry Mediastinal shift Adventitious sounds Hyperinflation Heart sounds

10 Preterm - Possible etiology
Early progressive - Respiratory distress syndrome or hyaline membrane disease (HMD) Early transient Asphyxia, metabolic causes, hypothermia Anytime Pneumonia

11 Term – Possible etiology
Early well looking TTNB, polycythemia Early severe distress MAS, asphyxia, malformations Late sick with Cardiac hepatomegaly Late sick with shock Acidosis Anytime Pneumonia

12 Suspect surgical cause
Obvious malformation Scaphoid abdomen Frothing History of aspiration

13 Investigations Gastric aspirate Polymorph count Sepsis screen
Chest X-ray Blood gas analysis

14 Shake test Take a test tube
Mix 0.5 ml gastric aspirate ml absolute alcohol Shake for 15 seconds Allow to stand 15 minutes for interpretation of result

15 Respiratory distress - Management
Monitoring Supportive - IV fluid - Maintain vital signs - Oxygen therapy - Respiratory support Specific

16 Oxygen therapy* Indications All babies with distress Cyanosis
Pulse oximetry SaO2 < 90% Method Flow rate 2-5 L/ min Humidified oxygen by hood or nasal prongs * Cautious administration in pre-term

17 Pulse oximetry Effective non invasive monitoring of oxygen therapy
Ideally must for all sick neonates and those requiring oxygen therapy Maintain SaO2 between 90 – 93 %

18 Respiratory distress syndrome (RDS)
Pre-term baby Early onset within 6 hours Supportive evidence: Negative shake test Radiological evidence

19 X-ray - RDS

20 Pathogenesis of RDS Decreased or abnormal surfactant Alveolar collapse
Impaired gas exchange Respiratory failure

21 RDS - Predisposing factors
Prematurity Cesarean born Asphyxia Maternal diabetes RDS - Protective factors PROM IUGR Steroids

22 Antenatal corticosteroid - Simple therapy that saves neonatal lives
Preterm labor weeks of gestation irrespective of PROM, hypertension and diabetes Dose: Inj Betamethasone 12mg IM every 24 hrs X 2 doses; or Inj Dexamethasone 6 mg IM every 12 hrs X 4 doses Multiple doses not beneficial

23 Surfactant therapy - Issues
Should be used only if facilities for ventilation available Cost Prophylactic Vs rescue

24 Dose 100mg/kg phospholipid Intra tracheal
Surfactant therapy - Issues Prophylactic therapy Extremely preterm <28 wks <1000 gm Not routine in India Rescue therapy Any neonate diagnosed to have RDS Dose 100mg/kg phospholipid Intra tracheal

25 Meconium aspiration syndrome (MAS)
Meconium staining - Antepartum, intrapartum Thin - Chemical pneumonitis Thick - Atelectasis, airway blockage, air leak syndrome

26 Meconium aspiration syndrome
Post term/SFD Meconium staining – cord, nails, skin Onset within 4 to 6 hours Hyperinflated chest

27 X-ray - MAS

28 MAS - Prevention Oropharyngeal suction before delivery of shoulder for all neonates born through MSAF Endotracheal suction for non vigorous* neonates born through MSAF *Avoid bag & mask ventilation till trachea is cleared

29 Transient tachypnoea of newborn (TTNB)
Cesarean born, term baby Delayed clearance of lung fluid Diagnosis by exclusion Management: supportive Prognosis - good

30 X-ray- TTNB

31 Congenital pneumonia Predisposing factors
PROM >24 hours, foul smelling liquor, Peripartal fever, unclean or multiple per vaginal Treatment Thermoneutral environment, NPO, IV fluids, Oxygen, antibiotics-(Amp+Gentamicin)

32 X-ray – Congenital pneumonia

33 Nosocomial pneumonia Risk Factor : Ventilated neonates
: Preterm neonates Prevention : Handwash : Use of disposables : Infection control measures Antibiotics : Usually require higher antibiotics

34 Respiratory distress in a neonate with asphyxia
Myocardial dysfunction Cerebral edema Asphyxial lung injury Metabolic acidosis Persistent pulmonary hypertension

35 Pneumothorax Etiology
Spontaneous, MAS, Positive pressure ventilation (PPV) Clinical features Sudden distress, indistinct heart sounds Management Needle aspiration, chest tube

36 X-ray - Pneumothorax

37 Persistent pulmonary hypertension (PPHN)
Causes Primary Secondary: MAS, asphyxia, sepsis Management Severe respiratory distress needing ventilatory support, pulmonary vasodilators Poor prognosis

38 Respiratory distress (needing referral)
RDS (HMD) MAS Surgical or cardiac cause PPHN Severe or worsening distress

Download ppt "Respiratory distress Cause of significant morbidity and mortality"

Similar presentations

Ads by Google